Risk for the majority of COVID-19 outcomes among patients with rheumatoid arthritis (RA) are largely comparable to that among individuals without rheumatic disease, according to results of a multicenter cohort study published in Seminars in Arthritis and Rheumatism. However, after adjusting for known COVID-19 risk factors, venous thromboembolism (VTE) and sepsis occurred at higher rates in the RA vs non-RA cohort. Among patients with RA, the male sex, Black race, and glucocorticoid use were independent risk factors for poor COVID-19 outcomes.
The current retrospective comparative cohort study included data from the TriNetX database, a research network of the electronic health records of 69 million patients from 49 United States health care organizations.
Eligible patients were diagnosed with COVID-19 between January 20, 2020 and April 11, 2021. Rheumatoid arthritis was identified using the appropriate diagnostic codes; a comparator cohort of patients without RA was also included in the analysis. Baseline demographic and clinical characteristics were collected. COVID-19 outcomes of interest included mortality, hospitalization, intensive care unit (ICU) admission, mechanical ventilation, severe COVID-19, acute kidney injury, kidney replacement therapy/hemodialysis, acute respiratory distress syndrome, ischemic stroke, VTE, and sepsis. Researchers compared COVID-19 outcomes between the RA and non-RA cohorts using 1:1 propensity score matching. Risk ratios (RRs) were also calculated for each outcome.
The study cohort included 9730 patients with RA and 656,979 patients without RA. The RA vs non-RA cohort had a higher mean age (61.1 vs 47.6 years, respectively) and a greater percentage of women (74.8% vs 55.0%, respectively). Patients with RA also more often had comorbidities, including hypertension, chronic lung disease, and heart failure.
Before propensity score matching, the RA cohort had elevated risk for all COVID-19 outcomes, including mortality, hospitalization, and ICU admission. However, after matching, the majority of outcome risks were comparable between 2 cohorts. However, the RA cohort had elevated risk for VTE (RR, 1.18; 95% CI, 1.01-1.38) and sepsis (RR, 1.27; 95% CI, 1.12-1.43) compared with the non-RA cohort.
Among the RA cohort, the male sex was associated with elevated risk for the majority of adverse outcomes, including hospitalization (RR, 1.19; 95% CI, 1.08-1.30), ICU admission (RR, 1.38; 95% CI, 1.10-1.73), and mechanical ventilation (RR, 2.02; 95% CI, 1.46-2.79).
Black race was another significant predictor of poor COVID-19 outcomes. Compared with White patients with RA, Black patients with RA were at greater risk for all adverse outcomes, except kidney replacement therapy/hemodialysis. In particular, Black patients with RA were at significantly elevated risk for death (RR, 1.69; 95% CI, 1.20-2.37), hospitalization (RR, 1.38; 95% CI, 1.23-1.54), ICU admission (RR, 1.65; 95% CI, 1.26-2.16), and mechanical ventilation (RR, 1.74; 95% CI, 1.22-2.48).
Glucocorticoid use also appeared to increase the risk for the majority of severe outcomes, including death (RR, 1.80; 95% CI, 1.42-2.28), hospitalization (RR, 1.40; 95% CI, 1.29-1.52), ICU admission (RR, 1.56; 95% CI, 1.27-1.92), and mechanical ventilation (RR, 1.75; 95% CI, 1.32-2.31). In an analysis of RA treatment regimens, risk for hospitalization was higher with rituximab (RR, 1.78; 95% CI, 1.24-2.54) and interleukin (IL)-6 inhibitors (RR, 1.50; 95% CI, 1.00-2.24) compared with tumor necrosis factor (TNF) inhibitors. Risk did not differ across the other drug classes studied.
Overall, in this large-scale, multicenter cohort study, risk for all COVID-19 outcomes was elevated in patients with RA. However, after propensity score matching, the majority of these associations were not observed, suggesting that the risk for the adverse outcomes may be attributable to other factors. Among the RA cohort, male sex, Black race, and glucocorticoid use were each associated with poor COVID-19 outcomes, which were aligned with findings from previous studies.
As study limitations, researchers noted that data on socioeconomic status, geographical location, health care access, and medication adherence were not available in the TriNetX database, because of which residual confounding may have been present in the analyses.
“[We] found that the risk of all outcomes was higher in the RA compared to the non-RA cohort before matching, with no difference in the majority of outcomes after matching,” the researchers wrote. “This finding implies that the risk for worse COVID-19 outcomes in RA compared to the non-RA cohort could be primarily related to older age and a higher proportion of comorbidities among the RA cohort.”
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Raiker R, DeYoung C, Pakhchanian H, et al. Outcomes of COVID-19 in patients with rheumatoid arthritis: a multicenter research network study in the United States. Semin Arthritis Rheum. 2021;51(5):1057-1066. doi:10.1016/j.semarthrit.2021.08.010